Health Promotoras tackle vaccine reluctance in Eastside Los Angeles

Published in collaboration with the USC Price Center for Social Innovation in Support of the Neighborhood Data for Social Change Platform (NDSC): The platform is a free, publicly available online data resource that provides reliable, aggregated data on the city, neighborhood, and census tract- Level. The mission of the USC Price Center for Social Innovation is to generate ideas and identify strategies to improve the quality of life for people in low-income urban communities.

Martha Gonzalez has been knocking on doors in the Boyle Heights neighborhood of Los Angeles since 2017. She encounters apathy, ignorance and disinformation in the service of the health education of her neighbors. Martha is a so-called Promotora; a trained layperson teaching basic health education in a community. She works for Clínica Romero, an organization that has been providing medical care to underserved Los Angeles communities since 1983. For the past four years, Clínica Romero’s promoters have brought vital health education on topics from women’s health to cancer to public housing and around Boyle Heights. Martha also lives in one of these facilities, Ramona Gardens, which uniquely qualifies her to get her message across to the underserved residents.

Clínica Romero’s partnership with USC began three years ago when USC University Relations received a grant from the California Wellness Foundation to review public housing facilities to determine why residents were not availing of federal and state health programs for low-income people. Although it’s close to a leading research hospital, the social determinants of health – these are the social, environmental, and economic conditions people live in – are few in the neighborhoods around the USC Health Sciences campus. The university wanted to understand the barriers preventing residents from receiving the benefits they were entitled to. USC brought in the Promotoras team from Clínica Romero & Martha to do the work.

A woman is vaccinated in a Clínica Romero tent. Last spring, the Clínica Romero teamed up with YMCA to set up vaccination centers. | Romero Clinic

The social housing neighborhoods are home to many Latino / a residents, and about a third of the population in the neighborhoods lives below the federal poverty line. More than half the population has less than a high school diploma and more than a quarter of households are “linguistically isolated,” meaning no one over 14 years old said they spoke “very good” English. As shown in the graph below, these numbers far exceed the Los Angeles County’s average.

Promotoras like Martha can be valuable envoys in overcoming cultural and linguistic barriers. You can speak to residents many of whom you know and receive honest answers that may not be shared with university researchers. The promotoras interviewed over 2,500 families and learned that fear and misinformation played a large role in residents’ reluctance to accept government health programs. They feared that the government would send them an invoice for services or that their immigration status would be compromised. Martha and her team were in the middle of this work when the COVID pandemic hit.

The pandemic hits

Clínica Romero staff watched the pandemic race west around the globe, knowing they had to act quickly. The California Wellness Foundation facilitated the realignment of funding towards humanitarian aid for COVID. The clinic quickly expanded its workforce by hiring students whose colleges had closed because of the virus. In March 2020, just two days after everything was closed, the Clínica Romero had put a food distribution network into operation. During the busy months leading up to the vaccination, Martha and the team distributed food, personal protective equipment and important training courses to the social housing they oversee. They held town halls with medical professionals briefing the public on the vaccine development process and best practices for preventing infection. When the vaccines were available last spring, there were still some funds left, so the Clínica Romero set up vaccination centers in the region in partnership with YMCA. Martha and the Promotoras went to work encouraging people to get vaccinated. As the surge in delta variants swept through Los Angeles, the team needed to use all of the trust it had built over the years to combat vaccination misinformation floating around the community. Residents feared vaccination for the same reasons they didn’t get state and state health insurance, but rampant misinformation about the vaccine on social media and from ill-informed family members compounded the hesitation problem. During a dire emergency like COVID-19, the promotoras were necessary channels for health information that could be conveyed with the authenticity of a neighborly visit. This slang approach made it possible to impart medical knowledge in a way that could break social barriers that may be insurmountable for more formal health workers.

Clinica Romero employees pack food.

Clínica Romero employees prepare and package food for distribution. | Romero Clinic

Make a difference

Martha and the Promotoras didn’t know whether they had moved the needle on the vaccination rates until the Clínica Romero received additional funding at the end of last summer to ask residents about their reluctance. It turns out it was worth the effort. In two of the three public housing units examined, vaccination rates are well above the Los Angeles County’s average. In Ramona Gardens, the vaccination rate is almost 92 percent. Dulce Acosta, Senior Principal Director for Community and Local Government Partnerships at USC, wants people to understand that this pandemic has spawned many informal first responders, people like Martha, who she says “risked her life every day, in order to do this”. work”.

The work goes on. The hesitant vaccination is one of the main reasons the pandemic is dragging on. One housing project in the area, William Mead, still has an adult vaccination rate five percent below the district average, but most of the hesitation is now focused on children. Of the vaccinated parents at Ramona Gardens, only 21 percent are interested in having their children vaccinated. This number was the highest among the four institutions advertised. In William Mead, only two percent of parents say they have their children vaccinated. These low numbers are unsurprising as the CDC only recently recommended vaccinating children, but they do underscore the work that promotoras like Martha have yet to do.

Given the success of the promotoras in association with the community, Clínica Romero has expanded the program. Martha currently oversees sixteen Promotoras with offices in Boyle Heights, Pico Union, Westlake, Panorama City and Van Nuys. In addition to providing basic health education, promotoras often find this job to be a stepping stone into public health careers. The success of the promotoras model has got around. Representatives from the National Association of Latino Elected Officials (NALEO) reached out to USC and Clínica Romero to expand their work. Martha is happy about the success of the promotoras program in the Clínica Romero, but her motivation comes from helping her neighbors. She says quite simply: “We are continuing this fight because it saves lives”.


Romero Clinic (2019)

Los Angeles County Department of Public Health, Office of Health Assessment and Epidemiology. (2017, January). Key Health Indicators by Performance Planning Area.

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